The ‘impatient optimist’: Bill Gates strengthens his commitment to the eradication of polio

On 29 January, Microsoft Chairman Bill Gates delivered the prestigious Richard Dimbleby lecture, and chose polio eradication as the subject of his address. Capitalising on his unique position as a leading voice in global health, Mr Gates outlined a comprehensive six-year plan to eradicate the disease, which he described as “the subject about which I am most impatient and most optimistic”.

Mr Gates acknowledged that his vocal resolve to eradicate polio is often met with curiosity and scepticism. One of the most common questions is why the international community, especially in these trying economic times, should invest so much in a disease which kills significantly fewer people than AIDS, malaria, or tuberculosis.

Mr Gates was emphatic in his response: polio is not a mere “historical curiosity”. The practical justification for investing in the eradication campaign lies in the deadly nature of the disease’s silent transmission. Only one percent of affected people show symptoms, while the remaining 99 percent are unknowingly contagious. Moreover, when symptoms show, they are not unique to polio. A diagnosis is only reached after weeks of physical tests, often involving extensive travel of the victim and his or her samples, by which time the virus may have spread extensively in any direction. Because of this, Mr Gates explained, “everybody everywhere is at risk at all times, unless they’re immune.” Eradication thus depends on the vaccination of practically the entire population of a country, to ensure that the virus has no reservoir in which to survive.

Emphasising the feasibility of his six-year plan, Mr Gates likened the rapid progress of the fight against polio to the pace of innovation in computer technology. It is certainly true that the campaign has made significant progress over the past 25 years. The number of recorded cases has decreased from approximately 350,000 per year to 650. Remarkable progress has also been made in containing the disease geographically as only three countries remain endemic today – Afghanistan, Nigeria and Pakistan – compared to 125 countries in 1988.

Recent technological developments suggest that the goal of eradication by 2018 is indeed attainable. Thanks to high resolution satellite imagery producing detailed maps of secluded areas, thousands of remote settlements can now be targeted. In this way, the scope and rigour of the vaccination campaign has radically transformed.

However, advanced technology will not guarantee eradication on its own: innovation must be coupled with broad and uncompromising public will if the fight is to be won. Misguided beliefs concerning links between vaccinations and infertility are one example of the remaining impediments to securing broad public will. Moreover, the recent brutal murders of volunteer vaccination workers in Pakistan were the gravest manifestation of the challenges which persist. As Mr Gates stated, “the nihilism behind these coordinated attacks, seeking out the goodness to destroy it, is the opposite of what the eradication fight is all about.”

Technological improvements in geographical accessibility are ineffectual if human obstacles remain. The safety of vaccination workers must be guaranteed, and accompanied by a broader effort to educate populations on the importance of vaccinations. Funds, commitment and resolve at grass-root levels are, therefore, the most critical variables, and perhaps the most elusive.

In this respect, the target of eradication by 2018 may prove to be ‘impatiently optimistic’. However, the commitment of one of the most influential figures in global health, reconfirmed during the Richard Dimbleby lecture, gives renewed hope to the cause. As Mr Gates concluded, the campaign is undoubtedly among the most difficult challenges the international community has ever assigned itself, but also one of the most important.

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